The combination of 5-fluorouracil/leucovorin (5-FU/LV) plus oxaliplatin (FOLFOX) is widely acknowledged as the standard regimen for second-line treatment in patients with advanced biliary tract ...cancer. Nanoliposomal irinotecan (nal-IRI) has demonstrated its activity in patients with advanced pancreatic cancer. Recent studies have investigated the activity of nal-IRI in combination with 5-FU/LV for biliary tract cancer. However, the results have been contradictory. We conducted a meta-analysis to assess survival outcomes and response rates in randomised trials investigating the activity of nal-IRI in previously treated biliary tract cancer patients.
We systematically collected potentially relevant findings from PubMed/Medline, the Cochrane library and EMBASE. Abstracts presented at major international oncological meetings were also reviewed. We extracted hazard ratios and 95% confidence intervals for progression-free survival and overall survival, as well as odds ratios and 95% confidence intervals for objective response rate. The outcomes of the accessible randomised studies evaluating the activity of nal-IRI plus 5-FU/LV were analysed.
The combination therapy exhibited a statistically significant decrease in the risk of progression (hazard ratio 0.70; 95% confidence interval 0.50-0.97) when compared with 5-FU/LV alone. Additionally, the dual regimen yielded longer overall survival and a higher objective response rate.
Our meta-analysis showed that nal-IRI plus 5-FU/LV had a superior activity in comparison with 5-FU/LV. Further investigations are required to elucidate the role of nal-IRI in this setting and to identify subgroups of patients who could derive the greatest benefit from its administration.
Solid epidemiological evidences connect obesity with incidence, stage and survival in pancreatic cancer. However, the underlying mechanistic basis linking adipocytes to pancreatic cancer progression ...remain largely elusive. We hypothesized that factors secreted by adipocytes could be responsible for epithelial-to-mesenchymal transition (EMT) induction and, in turn, a more aggressive phenotype in models of pancreatic preneoplastic lesions.
We studied the role of factors secreted by two adipogenic model systems from primary human bone marrow stromal cells (hBMSCs) in an in vitro experimental cell transformation model system of human pancreatic ductal epithelial (HPDE) cell stably expressing activated KRAS (HPDE/KRAS),Results:We measured a significant induction of EMT and aggressiveness in HPDE and HPDE/KRAS cell lines when cultured with medium conditioned by fully differentiated adipocytes (ADIPO
) if compared with the same cells cultured with medium conditioned by hBMSC (hBMSC
) from two different healthy donors. Several genes coding for soluble modulators of the non-canonical WNT signaling pathway, including FRZB, SFRP2, RSPO1, WNT5A and 5B were significantly overexpressed in fully differentiated adipocytes than in their respective in hBMSC. ADIPO
induced the overexpression and the nuclear translocation of the Frizzled family member receptor tyrosine kinase-like orphan receptor (Ror) 2 in HPDE and HPDE/KRAS cells. Vantictumab, an anti-Frizzled monoclonal antibody, reduced ROR2 nuclear translocation and in turn the EMT and aggressiveness in HPDE and HPDE/KRAS cells.
We demonstrated that adipocytes could induce EMT and aggressiveness in models of pancreatic preneoplastic lesions by orchestrating a complex paracrine signaling of soluble modulators of the non-canonical WNT signaling pathway that determine, in turn, the activation and nuclear translocation of ROR2. This signaling pathway could represent a novel target for pancreatic cancer chemoprevention. Most importantly, these factors could serve as novel biomarkers to select a risk population among obese subjects for screening and, thus, early diagnosis of pancreatic cancer.
PC remains one of the most lethal solid tumors, mainly because of its intrinsic chemoresistance. We recently identified TAK1 as a central hub integrating the most relevant signals sustaining PC ...chemoresistance. nal-IRI is a novel standard of care for metastatic PC patients who had beenpreviously treated with a gemcitabine-based therapy.We endeavoured to identify circulating markers for TAK1 activation predicting chemoresistance in this clinical setting.
In vivo activity of nal-IRI was validated in an orthotopic nude mouse model of PC cells expressing TAK1- specific shRNA or a scramble sequence as control. Using multiplex xMAP/Luminex technology,the samples from 77 metastatic PC patients progressing after gemcitabine and prospectively enrolled to receive nal-IRI + 5FU/LV were analysed for the plasma concentration of 20 different TH1and TH2cytokines.The optimal cut-off thresholds able to significantly predict patient outcome were obtained based on the maximization of the Youden index.
A significant tumour volume reduction in mice bearing shTAK1 PCtreated with nal-IRIwas detected, whereas controls were resistant to this agent. Differential gene expression profiling revealed CXCL8 as the most significantly downregulated gene coding for secreted proteins inOffice1 shTAK1PC cell lines. After a 27 month median follow-up, in the overall population the median progression-free survival (PFS) was 3.3 months (95% CI=3.039-3.561) and the median overall survival (OS) was 7.3 months (95% CI=5.487-9.113). Cox proportional hazard regression multivariate analysis confirmed CXCL8 as the circulating factor most significantly correlated with survival outcomes. Patients with CXCL8 higher than 16.68pg/mL cut-off value had a PFS of 2.8 vs 3.4 months (HR=2.61, 95% CI=1.42-4.79, p=0.0014), and an OS of 5.3 vs 8.9 months (HR=3.7, 95% CI=1.93-7.11, p=2.6e-05), respectively.
We identified CXCL8 as the most significant circulating marker of TAK1 activation. Our study candidates CXCL8 as a potential predictive biomarker of resistance to nal-IRI in gemcitabine-refractory PC patients.
The authors.
Associazione Italiana per la Ricerca sul Cancro (AIRC).
D. Melisi: Advisory / Consultancy, Research grant / Funding (institution): Shire. All other authors have declared no conflicts of interest.
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